This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Friday, 10 September 2010

The Stupid Things They Say

Here are some authentic quotes from hospital managers and chiefs, family members, doctors etc etc for your entertainment:

1. "Why do you need any more than 2 qualified Nurses on a 35 bedded ward? Two Nurses and two untrained ward assistants should be plenty".......said by my Chief Nurse who hasn't worked on a ward since John Lennon walked the earth. Is this what she is telling management? The cow.

2. "I don't want to hear any more whinging from you Nurses about protected mealtimes. If you get interrupted by doctors during that 15 minute window that you get to feed patients then stop feeding the patients. If I were a patient I would rather the Nurse attend ward rounds with the doctor and get me discharged rather than hand out meals"..............................Another Nurse leader from my hospital who is older than the hills and last did ward nursing in the 80's. She seems to miss the point that it is wrong to starve one dependent person in order to get healthy patients' discharge paper work in order. And they say that younger Nurses are the problem.

3. "Audits are basic nursing care in my book. Deal with it"........said by a medical manager when he was told by ward sisters that their are not enough Nurses to care for patients basic needs on general wards....................... let alone fill in time consuming audits for him. Hell, we can't even keep these people alive in the time we have when we ignore the form filing.

4. "Why do you need a second Nurse for your 30 bedded ward when I have already sent you two untrained 16 year old ward assistants who have never been to nursing school to help staff your ward for the shift? Deal with it and cope. AND we are sending you 6 admissions and don't give me that shit about not being able to handle the patients you all ready have"..............................................Bed Manager.

5."If the phone is ringing and you are busy don't answer it" ........said by a high level and as old as Moses Clinical Nurse Manager when she was told that we need a ward clerk because a Nurse cannot take time to answer the phone every 30 seconds. This is especially true when we are the only qualified nurse on duty and trying to stay on top of doctors orders and keep patients alive. Sounded sensible until:

6. " And if I hear one more complaint for a relative who phones up here to enquire about their family member because the Nurses aren't answering the phone right away there will be a disciplinary"........said by same manager on another occasion when we told her that the only RN on duty cannot spend 55 minutes out of every hour answering the phone without harming patients. Then it gets worse.

7.. "The idea of a 30 bed ward needing a ward clerk to answer the phone for the Nurse is ridiculous. The Nurses can do that. We are not paying for a ward clerk" ...said by same manager after a patient nearly died of a major error because a Nurse was on duty alone and trying to answer a phone that never stopped ringing rather than concentrating on her job. We (with the support of a medical consultant) were begging for a ward clerk. Again.

*update, they gave us two part time clerks dressed in scrubs who sit in front of the nurse's station painting their nails and telling dirty stories. They only work 4 hours a day. Part timers from the job centre. They don't answer the phone either.
8. "I don't know anything about a staffing problem with Nurses. "............said by our Chief executive publicly one year and 147 short staffing incident forms after I started this blog and 1 day after the press picked up on what is going on here. It was a few months after the recruitment freeze on Nurses and the hiring drive for untrained ward assistants on minimum wage instead.

9. " UntrainedCare assistants are Nurses too and as long as they are there you are not short staffed"............said by Chief Nurse (ancient trained) after I complained about being the only trained nurse for 20 patients with no one to help but a 17 year old child ward assistant who has never even thought about attending nursing school or any kind of training. That shift was so bad. Half of those patients didn't have life saving orders given by doctors implemented that shift because I was overwhelmed. And I ran my ass off for 12 hours non stop. Not one cup of tea, not one pee break. Got screamed at by consultants for stuff not being done too. Thanks for your support and understanding, asshole.

10. "The Nurses aren't taking care of my gran" and "The Nurses don't bother to answer the phone"....said by an idiot relative who likes to call the ward 5 times an hour and get her entire sibling set to do the same. All 9 of them. I can either take your idiotic phone calls all the time OR I can see to the patients. Doing both is physically impossible.

11. "Nurse I need you to stay with me uninterrupted for 10 minutes while I do this procedure. NOW."....said a by a registrar to me, after he showed up on the ward without warning to do a procedure. This was his greeting. The procedure was routine and non urgent.

12"And just how the fuck do you want me to do that? I am the only Nurse for 19 patients, 10 of them have family members up my ass and hostile over stupid shit. My patient in 4 has blood shooting out of his mouth and rectum and no IV access, two of my dementia patients are on the floor and one is spreading shit up the wall causing other patients to scream, the detoxer is trying to beat the care assistant with a drip stand, the phone is ringing off the hook. I have people on 4 hourly IV antibiotics that have been missing doses all day, I have patients who are on IV fluids whose bags have been dry for hours with urinary outputs dropping off and AAU are sending me three admissions. Oh and there are 3 other doctors here wanting the same thing from me for their patients. Fuck off out of my way NOW...............said by me to the Registrar in number 10 as I pushed past him and ran to the bleeder. That was my greeting.

13. We are the real nurses here because we do bed baths.....said by a ward assistant. The fuck you are. I have been running my ass off for hours managing hundreds of meds, drips, problems, etc etc while you did a few bedbaths between playing on your mobile and having fag breaks. Since you are not a nurse you cannot help me with the 6 IV meds due in the next 15 minutes, the phone calls, the orders, the treatments, the assessments, the admits and discharges etc. Seriously. Just bite me.

14. "Tough shit, I only care about my father, your problems are your problems you slag".............said by a visitor after I told her that I could not come right now and fix her dad's blanket because I have a critically ill patient going south with a page and a half of doctor's orders that are complicated and needed to be implemented immediately as in 5 minutes ago. She had grabbed my arm to ask me to fix her dad's blanket while I was running to the treatment room to get 02 masks and IV fluids.

15."The treatment of my mother in this place is appalling. You Nurses are pigs"...............................said by another happy visitor after I told her 24 stone mother that I could not lift her on my own and that I could not get her chocolate from the shop when she has a BM of 22 after insulin and is waiting to see if her legs need chopping off as a result of non compliance with her diabetes care.

16. "My taxes pay your wages"..............and what do my taxes pay for...the fucking boogeyman? To be honest I don't think your taxes pay for shit. That is why I am working so many unpaid hours and being forced to take on more patients than I can handle while being denied resources. It is why my workload triples just as I am getting a payfreeze. We all pay taxes, you are not special. That is why I won't kill one patient to come and deal with your dad's non urgent need right now. Hell, even if your taxes did cover the cost of this shit (and they don't sunshine), I still wouldn't kill one person in order to deal with another's non urgent need. You see love, missing a doctors order for a fast IV bolus of fluids because I am fluffing daddy's pillow could get a crashing patient killed and me in a whole lot of legal trouble. You need to sit down and try to behave like a grownup.

32 comments:

"We are not paying overtime or time in lieu just because your time management skills are poor" Response from 'matron' to complaints from the 2 qualified staff on 30 bed rehab ward that it was impossible to manage the needs of very complex patients with just 1 or 2 care assistants AND complete paperwork. "Prioritise". Fucking classic response from nurse manager when I was left as only trained with ONE care assistant on said ward. I miss medical. Like a fucking tumour.

But be careful in regular life. Patient complaints are particularly dangerous, always worth avoiding

It's good to have well documented incident forms about staffing levels, but keep the Consultants on side. You may need them when the shit hits the fan. It sounds like a large turd is airborne and heading towards a fan near you.

good to have you back. Your workplace continues to be a dangerous place to work as an RN / patients.+ the Trust seems to work in a parallel universe of its own.Look after your own health Anne as being burned out is worse. LEAVE. A nurse with your knowledge + skills should be sought after. Anna

They demand that the hospital pay for transport home because they have "no money" and "their taxes pay your wages" etc. They don't work yet they have expensive fags in their designer bag, a top range mobile phone, fake nails, drinking holidays, etc etc. We had a guy like this trash a treatment room because the hospital wouldn't pay for a taxi to bring his GF to visit.

My response would have been "Look here: my shit wage, my pay freeze, my unpaid hours with no breaks and running my ass off between more patients than I can handle because the trust "cannot afford to hire" is what pays for the CT head that you received because your worthless drunken ass fell over outside the nightclub.

Amublance, meds, dressings, scans, time etc it all costs ££££ and you can get your own self home.

Oh how I have missed your wit :0DIf I had my way, the only way to keep your PIN would be a mandatory shift per month on an acute ward...this would be for ANYONE who wanted to keep their nursing registration...RCN, NMC, Managers of any description. Then they might see that things have indeed moved on since the Summer of Love. I have so many run-ins with "managers" these days, I feel like I have a big bullseye on my butt.I get the feeling that Cameroon and his ilk will be cutting access to expensive NHS treatments for anyone that Joe Public feels is unworthy...so cancer patients and kids will be okay but alcoholics and IVDUs will not be welcome (apart from ED). I get the feeling that over the next 10 years we will end up with a two-tier system...foundation hospitals will only treat those who can "co-pay" aka a nice way of saying the hospital will pay for the bed and you will have to pay for the rest. Those who cannot contribute will end up in "community" hospitals without RNs, CT scanners or consultant cover at night. I hope I am wrong but I think its unlikely...

Its so sad and annoying - I trained in 1978 and I can see how things have changed and the fact that the current CNOs can't or choose not to is v sad - nursing failed to change as the paradigm shifted to more acute patients and more intensive treatments - we are still in the 70s apparently in our approach and expectations.

Thats the curse of the NHS I'm afraid. The dirty little secret that no one wants to admit to the public...it can only stay free if we carry on to behave as though its the 1970s. Acute medicine today is expensive...a stay on the ICU is between £1500 and £5000 a day depending on what we do to you. Many of our patients spend up to a week following "deteriorating" on an acute ward due to old age or chronic disease (lung, liver, kidney). Twenty years ago they would have died on the ward as ICU would not have been able to help them. Now we have NIV, CPAP and renal replacement therapy to order. The other end of the spectrum sees young patients who abuse their bodies with fags, booze, drugs and fatty foods...these are often "repeat offenders" and seem to treat the NHS as a detox clinic. Its their right, don't you know. Nothing is more depressing than telling someone "you are going to DIE unless you change your lifestyle" and have them tell you to f*** off. Wave them goodbye as you take them to a medical ward and then count off the days until they are back in again. Eventually they will die on the ICU, or in a heap on the street somewhere. One of our consultants estimated that these patients are costing around £100,000 a year each and thats a pretty conservative estimate, I think...no wonder the NHS is going down the toilet.

Our management (like all others) are now really stressing over the huge debt and the need to save money, any which way possibe. At a recent meeting it was suggested that in order to claw back some pennies, the nurses work one day a month.....UNPAID.

Hello, I think your website might be having browser compatibility issues.When I look at your blog in Safari, it looks fine but when opening in Internet Explorer, it has some overlapping.I just wanted to give you a quick heads up! Other then that, amazing blog!

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.